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An ear infection is an inflammation of the middle ear, typically caused by bacteria. These infections occur when excess fluid builds up behind the eardrum.

According to a report by the National Institute on Deafness and Other Communication Disorders, anyone can get an ear infection, but children are more susceptible. Five out of six children have at least one by their 3rd birthday, the report said.

Dr. Robert Katz, a physician at Eastside ENT in Willoughby, and Bridgid Whitford, director of hearing services at the Cleveland Hearing and Speech Center in Cleveland, said ear-infection symptoms and conditions vary from person to person.

Katz said there are three types of ear infections: external ear infections, middle ear infections and inner ear infections.

“Acute external ear infections are generally the result of trauma, as with cotton sticks or other direct trauma like a bobby pin or pencil point, or prolonged water exposure,” he said. “Acute external otitis is painful and the ear is tender. Generally, the ear feels blocked and often there is drainage. It may follow an acute episode, but is often more of a chronic skin problem which results in poor wax formation.”

Katz said the three types of ear infections all have a similar underlying cause.

“It begins with poor eustachian tube function that results in a vacuum being created in the middle ear,” he explained. “This vacuum sucks fluid out of the surrounding capillary system as well as sucking in the eardrum, resulting in what is called retraction. The retraction may result in the accumulation of dead skin in a retraction pocket which will expand when it gets wet and can destroy the bone. The pocket is called cholesteatoma.”

Whitford said the most common complaint associated with chronic ear infections is that the ear feels stuffy, like when changing altitudes in an airplane.

“If you’re unable to pop your ears, that indicates fluid is starting to build up,” she noted. “It can also cause one’s balance to be off, as the balance organ is in the inner ear.”

The reason why ear infections are more common with children lies in the structure of their eustachian tube.

“The Eustachian tube, which is the drainage tube from your middle ear to the back fo your throat, is more horizontal in children,” Whitford said. “When they are little and that is laying horizontal, it is less easily drained and can become clogged. It’s just anatomy.”

But for older individuals, smoking can also cause problems with the eustachian tube, which can lead to chronic ear infections.

“What happens is the tube can get inflamed and it can’t open and close because it’s swollen shut,” Whitford explained. “You have that middle ear area acting as a vacuum.”

If an ear infection is left untreated, many things can occur. Most commonly, individuals can suffer from hearing loss. For children, this can be developmentally detrimental.

“For children, even the most minimal amount of hearing loss can be impactful,” Whitford stated. “As an adult, if you’re missing a few things that you can’t hear, you can fill in the blanks. For a child, when they go through their day, almost everything is new. They don’t have a bag of tricks to fill in the blanks. When they miss what is being said, they just miss it. And with muffled hearing, that can cause speech delays.”

Katz said the conditions are very similar in children and adults, but small differences lead to different treatments.

“Interrupting these processes begins, often in childhood, by placing pressure equalizing tubes, eliminating the vacuum and breaking the chain of events,” he said. “Once irreversible changes have occurred, only surgical correction has any efficacy in resolving the problem. ... In acute otitis externa, the ear should be protected from water and direct trauma.”

Though many times ear infections, especially in young children, will resolve on its own, it’s important to have a baseline, Whitford said.

“What is important is establishing today that we know there is hearing loss,” she said. “We want people to seek treatment so it’s documented. You want that baseline so whenever there is a concern about hearing loss or fluid, you want it documented so you can start the clock ticking in case more aggressive treatment is needed.”

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